Ophthalmology and Optometry Coding Alert

Question: My ophthalmologist performed a needling procedure during the postoperative period of a trabeculectomy to lower a patients IOP. Can I bill the needling procedure separately or is it considered included because it falls under the trabeculectomys global surgical package? South Carolina Subscriber Answer: The majority of services that are related to the initial procedure and performed in the postoperative period are considered included in and not separately billable from the initial procedure, but because this postoperative service was performed for a complication of the initial procedure, it may be separately billable it all depends on where the needling procedure was performed. You can separately report the needling of the bleb, 66250 (Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure), using modifier -78 (Return to the operating room for a related procedure during the postoperative period) but only if the needling of the bleb was performed in an operating room setting. Hospital operating rooms, ambulatory surgical centers and designated laser procedure suites are all considered operating room setting by Medicare and most Medicare carriers. If, however, the needling procedure was performed in a non-operating room setting, e.g., in the office or minor procedure room, the procedure is not separately billable. Answers to You Be the Coder and Reader Questions provided by Nicola DuHamel, health services administrator in Miami; and Raequell Duran, president, Practice Solutions in Santa Barbara, Calif. .